Os estudos que fornecem os animais foram financiados pelo Departamento de Alimentos, Meio Ambiente e Assuntos Rurais do Reino Unido e pela União Europeia (por meio de financiamento do Laboratório de Referência do TSE da UE). Reconhecemos o apoio dos gerentes de projeto, Dr.M. Simmons e Dr.M. Jeffrey.

1. Avaliação da Postura
<ol><li>Avalie a postura do animal enquanto não foi perturbado.</li>
	<li>Os animais afetados por TSEs podem ficar com membros de base larga, podem parecer curvados ou podem ficar com um carro de cabeça baixa.</li>
</ol>2. Avaliação do Comportamento
<ol><li>Estude o comportamento do animal, quando deixado sozinho, quando abordado, e quando manuseado.</li>
	<li>Animais afetados pelo TSE podem apresentar mentação alterada ficando separadamente de outras ovelhas ou não seguindo imediatamente outras ovelhas.</li>
	<li>Quando o animal é abordado, ele pode fugir e desmaiar, ou ele cai no chão quando manuseado. O sentido horário compulsivo ou no sentido anti-horário pode ser visto em ovelhas com raspagem atípica.</li>
</ol>3. Teste de resposta a ameaças
<ol><li>Segure a cabeça do animal para testar a resposta à ameaça: mova a mão ou vários dedos várias vezes em direção a cada olho do animal para induzir uma resposta piscando, mas tenha cuidado para não tocar em nenhum pelos faciais ou criar qualquer turbulência de ar que possa fazer o animal piscar.</li>
	<li>A resposta à ameaça pode estar ausente em animais afetados por sucata, particularmente em ovelhas com raspagem atípica. Embora o teste da resposta à ameaça seja o único teste nervoso craniano usado como parte do protocolo, a inspeção visual do rosto durante este procedimento pode revelar outros sinais de déficits neurológicos normalmente não vistos em scrapie, por exemplo, paralisia facial. Se o animal não piscar em resposta à ameaça é aconselhável testar o reflexo palpebral tocando as pálpebras para garantir que a incapacidade do animal de piscar não seja causada por paralisia facial.</li>
</ol>4. Teste da resposta de arranhões
<ol><li>Certifique-se de que o animal está calmo durante este procedimento porque o teste não pode ser interpretado em um animal em dificuldades.</li>
	<li>Raspar áreas das costas nas regiões torácica, lombar e sacral, parando entre cada episódio de arranhão.</li>
	<li>Se o animal responder com movimentos rítmicos da cabeça ou do corpo, ou se mover ou lamber os lábios ao arranhar uma determinada área, repita o teste de arranhão para confirmar a reprodutibilidade da resposta ao arranhão.</li>
	<li>Uma resposta repetível é geralmente provocada em animais que são pruriticos, que geralmente incluem ovelhas com scrapie clássico ou cabras com a forma pruritica de scrapie, mas geralmente não há resposta em ovelhas com sucata atípica a menos que outras condições de pele pruritica ou ectoparasitas estejam presentes.</li>
</ol>5. Verificação de perda de lã e lesões de pele
<ol><li>Inspecione a pele.</li>
	<li>Prurido devido a raspagem geralmente causa queda de cabelo, que pode estar na pesquisa, costas, garupa, lado do peito ou abdômen devido a esfregar ou arranhar excessivamente onde a pele subjacente parece normal.</li>
	<li>As abrasões podem aparecer mais tarde se o animal tiver a oportunidade de esfregar objetos pontiagudos. Ferimentos de mordida podem aparecer, particularmente nos membros, devido ao excesso de mordiscar os membros.</li>
</ol>6. Condição do corpo de pontuação
<ol><li>Avalie a condição corporal do animal palpando os processos dorsais e transversais das vértebras lombares.</li>
	<li>Scrapie pode causar uma perda progressiva da condição corporal onde os processos transversais das vértebras lombares podem ser facilmente sentidos individualmente, e as extremidades dos processos parecem nítidas.</li>
</ol>7. Vendar o Animal
<ol><li>Cubra os olhos do animal com um capuz, que pode ser feito usando qualquer saco não-ver-através onde um canto é cortado para permitir a respiração do animal.</li>
	<li>Solte o animal somente se não houver preocupações de segurança, e não há risco de ferimentos devido a um animal em pânico; caso contrário, manter o porão das ovelhas e estudar os movimentos dos animais enquanto ainda está no controle do animal.</li>
	<li>A venda pode exacerbar sinais de um sistema vestibular ou disfunção cerebelar, que pode ser obscurecida pela capacidade do animal de compensar através de sua visão. A perda de equilíbrio, a incoordenação ou a circlínica podem ser provocadas, particularmente em ovelhas clinicamente não notáveis com scrapie atípico.</li>
</ol>8. Avaliação do Movimento animal
<ol><li>Estude a marcha e os movimentos musculares do animal quando ele se move livremente.</li>
	<li>A incoordenação pode ser caracterizada por movimentos de base ampla dos membros traseiros, pulando com ambos os membros traseiros, ou balançando excessivamente nos quartos traseiros, o que pode resultar em tropeços ou brevemente sentados.</li>
	<li>A presença de um tremor na cabeça é muitas vezes sutil quando o animal não é perturbado, mas pode se tornar mais perceptível durante ou após a conclusão do exame clínico.</li>
</ol>9. Interpretação
<ol><li>Considere o significado dos achados em relação ao scrapie.</li>
	<li>Embora a presença de sinais individuais, como uma resposta repetível a arranhões, tremores, comportamento anormal, circulando, episódios em colapso, ataxia, ou uma resposta à ameaça ausente, possa ter várias causas, a ocorrência combinada de dois ou mais desses sinais é altamente sugestiva de scrapie em ovelhas ou cabras.</li>
</ol>

<ol>
	<li>Benestad, S. L., Arsac, J. N., Goldmann, W., N&#246;remark, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Atypical/Nor98+scrapie:+properties+of+the+agent,+genetics,+and+epidemiology.">Atypical/Nor98 scrapie: properties of the agent, genetics, and epidemiology.</a> Vet Res.. 39 (4), 19 (2008).</li><li>D&#39;Angelo, A., Maurella, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+clinical+criteria+to+diagnose+scrapie+in+Italy.">Assessment of clinical criteria to diagnose scrapie in Italy.</a> Vet. J. 174 (1), 106-112 (2007).</li><li>Eloit, M., Adjou, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=BSE+agent+signatures+in+a+goat.">BSE agent signatures in a goat.</a> Vet. Rec. 156 (16), 523-524 (2005).</li><li>Fediaevsky, A., Maurella, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+prevalence+of+atypical+scrapie+in+sheep+from+positive+flocks+is+not+higher+than+in+the+general+sheep+population+in+11+European+countries.">The prevalence of atypical scrapie in sheep from positive flocks is not higher than in the general sheep population in 11 European countries.</a> BMC Vet. Res. 6, 9 (2010).</li><li>Healy, A. M., Weavers, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+clinical+neurology+of+scrapie+in+Irish+sheep.">The clinical neurology of scrapie in Irish sheep.</a> J. Vet. Intern. Med. 17 (6), 908-916 (2003).</li><li>Houston, E. F., Gravenor, M. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+signs+in+sheep+experimentally+infected+with+scrapie+and+BSE.">Clinical signs in sheep experimentally infected with scrapie and BSE.</a> 152 (11), 333-334 (2003).</li><li>Kittelberger, R., Chaplin, M. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Atypical+scrapie/Nor98+in+a+sheep+from+New+Zealand.">Atypical scrapie/Nor98 in a sheep from New Zealand.</a> J. Vet. Diagn. Invest. 22 (6), 863-875 (2010).</li><li>Konold, T., Bone, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Associations+of+clinical+signs+and+prion+protein+genotypes+in+British+sheep+with+scrapie.">Associations of clinical signs and prion protein genotypes in British sheep with scrapie.</a> Dtsch. Tier&#228;rztl. Wochenschr. 116 (11), 380-388 (2009).</li><li>Konold, T., Bone, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Scrapie+in+goats.">Scrapie in goats.</a> Vet. Rec. 161 (11), 395-396 (2007).</li><li>Konold, T., Bone, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pruritus+is+a+common+feature+in+sheep+infected+with+the+BSE+agent.">Pruritus is a common feature in sheep infected with the BSE agent.</a> BMC Vet. Res. 4, 16 (2008).</li><li>Konold, T., Bone, G. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Monitoring+of+clinical+signs+in+goats+with+transmissible+spongiform+encephalopathies.">Monitoring of clinical signs in goats with transmissible spongiform encephalopathies.</a> BMC Vet. Res. 6, 13 (2010).</li><li>Konold, T., Davis, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+findings+in+two+cases+of+atypical+scrapie+in+sheep:+a+case+report.">Clinical findings in two cases of atypical scrapie in sheep: a case report.</a> BMC Vet. Res. 3, 1 (2007).</li><li>Passler, T., Walz, P. H., Pugh, D. G., Pugh, D. G., Baird, A. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Diseases of the Neurologic System. In: Sheep and Goat Medicine. , 361-405 (2012).</li><li>Russel, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Body+condition+scoring+of+sheep.">Body condition scoring of sheep.</a> In Pract. 6 (3), 91-93 (1984).</li><li>Simmons, H. A., Simmons, M. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Atypical+scrapie+in+sheep+from+a+UK+research+flock+which+is+free+from+classical+scrapie.">Atypical scrapie in sheep from a UK research flock which is free from classical scrapie.</a> BMC Vet. Res. 5, 8 (2009).</li><li>Simmons, M. M., Konold, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+natural+atypical+scrapie+phenotype+is+preserved+on+experimental+transmission+and+sub-passage+in+PRNP+homologous+sheep.">The natural atypical scrapie phenotype is preserved on experimental transmission and sub-passage in PRNP homologous sheep.</a> BMC Vet. Res. 6, 14 (2010).</li><li>Spiropoulos, J., Lockey, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Isolation+of+prion+with+BSE+properties+from+farmed+goat.">Isolation of prion with BSE properties from farmed goat.</a> Emerg. Infect. Dis. 17 (12), 2253-2261 (2011).</li><li>Ulvund, M. J., H&#246;rnlimann, B., Riesner, D., Kretzschmar, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Clinical Findings in Scrapie. In: Prions in humans and animals. , 398-407 (2006).</li></ol>

Todos os procedimentos envolvendo animais foram realizados de acordo com a Lei de 1986, sob licença do Ministério do Interior do Governo do Reino Unido. Os autores declaram que não têm interesses financeiros concorrentes.

Scrapie é uma doença listada pela Organização Mundial da Saúde Animal (OIE), que, na ausência de um teste pré-mortem rápido e confiável, conta com a capacidade dos agricultores ou veterinários de reconhecer os sinais clínicos associados a essa doença. A maioria dos casos de scrapie, particularmente atípicos, no entanto, são atualmente encontrados pela vigilância do TSE, ou seja, por exame cerebral de pequenos ruminantes sujeitos a abate ou animais de estoque caídos. A criação de ovelhas para resistência ao scrapie clássico, que reduziu o número de casos clássicos de scrapie, provavelmente também reduziu a conscientização das pessoas para a doença, de modo que é menos frequentemente considerada no diagnóstico diferencial de distúrbios neurológicos em ovinos. O scrapie atípico também tem baixa prevalência com aproximadamente cinco casos em matadouros e oito casos em estoque caído por 10.000 testados na Europa4. Além disso, o prurido, geralmente evidente como alopecia com ou sem excoriação, é muitas vezes considerado um sinal característico de scrapie13. Assim, uma doença neurológica sem prurido concomitante como observado no scrapie atípico12 ou na forma nãoprúrida de scrapie11 caprino não pode levantar suspeita de scrapie.
Este protocolo de exame foi concebido para identificar sinais clínicos do TSE em ovinos, avaliando sinais clínicos específicos associados a vários tipos de scrapie (scrapie atípico e clássico, este último representado por uma ovelha atípica BSE-inoculada, que apresentava sinais clássicos de scrapie). No scrapie clássico, a porcentagem de casos que apresentaram uma resposta positiva de risco ("reflexo de mordiscar") variou de 50 a 77 em mais de 100 ovinos estudados5,8. Os transtornos de movimento podem ser observados em até 81% dos casos clássicos de scrapie com base em vários estudos18. A incoordenação também é um grande sinal em vários casos de scrapie atípico, muitas vezes acompanhados de alterações comportamentais1, mas sinais adicionais relatados tanto em ovelhas de scrapie atípicas e experimentalmente infectadas foram circulantes e deficiência visual12,15,16, razão pela qual a venda de olhos e os testes da resposta à ameaça estão incluídos no protocolo de exame. A pontuação da condição corporal, por exemplo, utilizando um sistema de pontuação de 6 pontos14,permite a avaliação da emaciação, que pode ser observada em ovelhas afetadas por sucata5. Embora os critérios clínicos para auxiliar na detecção de scrapie em ovelhas tenham sido propostos anteriormente2, estes apenas relacionados à detecção de scrapie clássico e levaram em conta o histórico clínico, que pode não estar disponível se os animais forem apresentados em um matadouro.
O protocolo atual permite a triagem de muitos animais para sinais de sucata em um curto período de tempo. Além disso, o protocolo de exame pode ser aplicado a estudos experimentais de sucata em ovinos e caprinos para monitorar o início clínico, a progressão e o ponto final. No entanto, não substitui um exame físico e neurológico mais detalhado pelo registro adequado do histórico de casos clínicos, possivelmente seguido de testes diagnósticos auxiliares (exame de sangue e fluido cefalorraquidiano; técnicas de imagem mais sofisticadas, se for o caso), o que pode ser necessário posteriormente para descartar várias outras condições em pequenos ruminantes que apresentam sinais semelhantes , como doenças neurológicas metabólicas ou inflamatórias, abscessos cerebrais ou tumores.
Embora um exame clínico seja geralmente menos sensível na detecção de animais afetados pelo TSE do que testes post mortem baseados na detecção de proteína de prípria2,11, particularmente em um estágio inicial do período de incubação, este é atualmente o único método de detecção em animais vivos e mais relevante para os países que não possuem um sistema de vigilância direcionado para identificar pequenos ruminantes afetados pelo TSE.

Scrapie é uma encefalopatia espongiforme transmissível (TSE) de ovelhas e cabras, que pertence ao grupo de distúrbios de dobra de proteínas, como encefalopatia espongiforme bovina (EEB) em bovinos, doença de desocupação crônica em veados e doença de Creutzfeldt-Jakob em humanos. O diagnóstico é feito após a morte, detectando a forma anormal da proteína prion, que é resistente à proteína, geralmente no cérebro. Duas grandes formas de scrapie que ocorrem naturalmente podem ser distinguidas, que são epidemiológicas, patologicamente e bioquimicamente diferentes: scrapie clássico e scrapie atípico. Além disso, uma doença neurológica com sinais clínicos clássicos semelhantes a scrapie pode ser induzida em ovelhas e cabras por infecção experimental com o agente BSE6,10-11. De fato, a EE de ocorrência natural foi diagnosticada em cabras3,17. O controle do scrapie clássico (e da EE em ovelhas se ocorreu naturalmente) tem sido alcançado pela reprodução para resistência genética visando o gene da proteína prion, mas isso é mais difícil para o scrapie atípico, que acredita-se ser uma doença esporádica e foi diagnosticado em países considerados livres de scrapie clássico, por exemplo, Nova Zelândia7.
Scrapie é uma doença neurológica de ovinos e caprinos adultos que resultam em mudanças de comportamento, sensação e movimento, mas a doença é lentamente progressiva, e os sinais clínicos muitas vezes não são reconhecidos porque o protetor animal ou cirurgião veterinário pode não estar familiarizado com os sinais clínicos, ou scrapie não é considerado em tudo no diagnóstico diferencial de doenças neurológicas em pequenos ruminantes.
O protocolo de exame proposto foi concebido para auxiliar no diagnóstico clínico de scrapie com dois propósitos em mente: deve ser consideravelmente breve permitir a varredura de muitos animais em um curto período de tempo, mas específico o suficiente para permitir a detecção de animais afetados por sucata, o que é alcançado avaliando a presença de sinais clínicos frequentemente encontrados em animais afetados por sucata. Este protocolo é uma pequena modificação do usado para monitorar cabras em busca de sinais de scrapieclássico 11 e inclui vendagen do animal, o que pode exacerbar sinais clínicos normalmente não associados ao scrapie9.

clinical examination protocol to detect atypical and classical scrapie in sheep

O diagnóstico de scrapie, uma encefalopatia esponiforme transmissível (TSEs) de ovelhas e cabras, baseia-se atualmente na detecção de proteína prion associada à doença por testes post mortem. A menos que uma amostra aleatória da população de ovinos ou caprinos seja ativamente monitorada para scrapie, a identificação de casos de scrapie depende do relato de suspeitos clínicos, o que depende da familiarização do indivíduo com a doença e da capacidade de reconhecer sinais clínicos associados ao scrapie. O scrapie não pode ser considerado no diagnóstico diferencial de doenças neurológicas em pequenos ruminantes, particularmente em países com baixa prevalência de scrapie, ou não reconhecido se apresenta como forma nãoprúrrica como sucata atípica. Para auxiliar na identificação de suspeitos clínicos, é apresentado um protocolo de exame curto para avaliar a exibição de sinais clínicos específicos associados a formas pruriticas e nãoprúrticas de TSEs em ovinos, que também poderiam ser aplicadas às cabras. Isso inclui avaliação de comportamento, visão (por teste da resposta à ameaça), prurido (testando a resposta ao arranhão) e movimento (com e sem vendas). Isso pode levar a um exame neurológico mais detalhado de relatar animais como suspeitos de sucata. Também pode ser usado em estudos experimentais do TSE de ovinos ou caprinos para avaliar a progressão da doença ou identificar ponto final clínico.

Ovelhas clinicamente saudáveis. Poll Dorset wether de um rebanho sem arranhões intracerebrally inoculado com cérebro bovino de origem neozelandesa e examinado aos 49 meses após a inoculação. Esta ovelha tem uma postura normal, se comporta normalmente, exibe uma resposta normal de ameaça(Figura 1),não reage ao teste de arranhão, tem um velo intacto, e uma condição corporal muito boa. É clinicamente incomum quando vendado e não mostra sinais de distúrbio de movimento.
Ovelhas de scrapie atípicas apresentando a forma nãoprúrtica de TSEs em ovelhas. Cheviot wether de um rebanho livre de arranhões intracerebrally inoculado com homogeneizar cérebro de um caso atípico de campo de sucata do mesmo genótipo de proteína de prion (AHQ/AHQ) e examinado aos 36 meses após a inoculação. Esta ovelha também tem uma postura normal, mas se comporta de forma diferente com as outras ovelhas na caneta e circula no sentido horário. Não pisca quando a resposta à ameaça é testada. Arranhar não provoca nenhuma resposta, e nenhuma mudança de lã é aparente, mas a condição corporal é justa. Ele circula no sentido horário quando vendado(Figura 2) e perde o equilíbrio. A marcha é ataxic, e um tremor fino na cabeça é visível.
Ovelhas BSE atípicas apresentando a forma pruritica de TSEs em ovelhas, que é clinicamente semelhante à apresentação clínica de ovelhas clássicas afetadas por scrapie. Por essa razão, um caso clássico de scrapie não está incluído. Poll Dorset wether de um rebanho sem raspagem intracerebrally inoculado com peitoico atípico (tipo L) cérebro BSE e examinado aos 50 meses pós-inoculação. Esta ovelha fica ligeiramente curvada, tende a manter os membros traseiros de base larga e cai no chão quando pego. A resposta à ameaça é fraca. O arranhão de várias áreas da parte de trás provoca movimentos de cabeça ou lábio(Figura 3),e há perda de lã com trauma de pele menor na pesquisa. O estado do corpo é bom. Quando vendado, reluta em se mover e descansa sua parte traseira no obstáculo para manter o equilíbrio. A ovelha é ataxic e exibe hipermetria de membros do antepé.
<img alt="Figure 1" fo:content-width="5in" fo:src="/files/ftp_upload/51101/51101fig1highres.jpg" src="/files/ftp_upload/51101/51101fig1.jpg"> Figura 1. Teste de resposta à ameaça. Gesto ameaçador em direção ao olho do animal induz uma resposta piscando. <a href="https://www.jove.com/files/ftp_upload/51101/51101fig1highres.jpg" target="_blank">Clique aqui para ver imagem maior.</a>
<img alt="Figure 2" fo:content-width="5in" fo:src="/files/ftp_upload/51101/51101fig2highres.jpg" src="/files/ftp_upload/51101/51101fig2.jpg"> Figura 2. Vendando. No sentido horário, circulando provocado por vendar as ovelhas com um capuz. <a href="https://www.jove.com/files/ftp_upload/51101/51101fig2highres.jpg" target="_blank">Clique aqui para ver imagem maior.</a>
<img alt="Figure 3" fo:content-width="5in" fo:src="/files/ftp_upload/51101/51101fig3highres.jpg" src="/files/ftp_upload/51101/51101fig3.jpg"> Figura 3. Teste da resposta de arranhões. O arranhão da parte de trás provoca lambida labial com movimentos laterais da cabeça <a href="https://www.jove.com/files/ftp_upload/51101/51101fig3highres.jpg" target="_blank">Clique aqui para ver imagem maior.</a>

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Clinical Examination Protocol to Detect Atypical and Classical Scrapie in Sheep

Um protocolo de exame clínico curto é apresentado para auxiliar na detecção de sucata clássica e atípica em ovelhas e cabras.

Protocolo de Exame Clínico para Detectar Scrapie Atípico e Clássico em Ovelhas

The diagnosis of scrapie, a transmissible spongiform encephalopathy (TSEs) of sheep and goats, is currently based on the detection of disease-associated ...

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12.7K visualizações.  Animal Health and Veterinary Laboratories Agency Weybridge. Um protocolo de exame clínico curto é apresentado para auxiliar na detecção de sucata clássica e atípica em ovelhas e cabras.

Vídeo: Clinical Examination Protocol to Detect Atypical and Classical Scrapie in Sheep

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is respect for patient's values, preferences, and expressed needs. Yet specific approaches to gaining this understanding and translating it to quality care in the clinical setting are lacking. From a patient perspective quality is not a simple concept but is best understood in terms of five dimensions: technical outcomes; decision-making efficiency; amenities and convenience; information and emotional support; and overall patient satisfaction. Failure to consider quality from this five-pronged perspective results in a focus on medical outcomes, without considering the processes central to quality from the patient's perspective and vital to achieving good outcomes. In this paper, we argue for applying the concept of fair process in clinical settings. Fair process involves using a collaborative approach to exploring diagnostic issues and treatments with patients, explaining the rationale for decisions, setting expectations about roles and responsibilities, and implementing a core plan and ongoing evaluation. Fair process opens the door to bringing patient expertise into the clinical setting and the work of developing health care goals and strategies. This paper provides a step by step illustration of an innovative visual approach, called photovoice or photo-elicitation, to achieve fair process in clinical work with acquired brain injury survivors and others living with chronic health conditions. Applying this visual tool and methodology in the clinical setting will enhance patient-provider communication; engage patients as partners in identifying challenges, strengths, goals, and strategies; and support evaluation of progress over time. Asking patients to bring visuals of their lives into the clinical interaction can help to illuminate gaps in clinical knowledge, forge better therapeutic relationships with patients living with chronic conditions such as brain injury, and identify patient-centered goals and possibilities for healing. The process illustrated here can be used by clinicians, (primary care physicians, rehabilitation therapists, neurologists, neuropsychologists, psychologists, and others) working with people living with chronic conditions such as acquired brain injury, mental illness, physical disabilities, HIV/AIDS, substance abuse, or post-traumatic stress, and by leaders of support groups for the types of patients described above and their family members or caregivers.

This paper illustrates an innovative visual approach (photovoice or photo-elicitation) to achieve fair process in clinical care for patients living with chronic health conditions, illuminate gaps in clinical knowledge, forge better therapeutic relationships, and identify patient-centered goals and possibilities for healing.

Usando métodos visual e narrativa para atingir Processo Fair em Cuidados Clínicos

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is ...

Medicina

EEG Mu Rhythm in Typical and Atypical Development

Electroencephalography (EEG) is an effective, efficient, and noninvasive method of assessing and recording brain activity. Given the excellent temporal resolution, EEG can be used to examine the neural response related to specific behaviors, states, or external stimuli. An example of this utility is the assessment of the mirror neuron system (MNS) in humans through the examination of the EEG mu rhythm. The EEG mu rhythm, oscillatory activity in the 8-12 Hz frequency range recorded from centrally located electrodes, is suppressed when an individual executes, or simply observes, goal directed actions. As such, it has been proposed to reflect activity of the MNS. It has been theorized that dysfunction in the mirror neuron system (MNS) plays a contributing role in the social deficits of autism spectrum disorder (ASD). The MNS can then be noninvasively examined in clinical populations by using EEG mu rhythm attenuation as an index for its activity. The described protocol provides an avenue to examine social cognitive functions theoretically linked to the MNS in individuals with typical and atypical development, such as ASD.&#160;

Assessment of the EEG mu rhythm provides a unique methodology for examining brain activity and when combined with behaviorally based assays, can be a powerful tool for elucidating aspects of social cognition, such as imitation, in clinical populations.

EEG Mu Ritmo no desenvolvimento típico e atípico

Electroencephalography (EEG) is an effective, efficient, and noninvasive method of assessing and recording brain activity. Given the excellent temporal ...

A Neuroscientific Approach to the Examination of Concussions in Student-Athletes

Concussions are occurring at alarming rates in the United States and have become a serious public health concern. The CDC estimates that 1.6 to 3.8 million concussions occur in sports and recreational activities annually. Concussion as defined by the 2013 Concussion Consensus Statement &#8220;may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an &#8216;impulsive&#8217; force transmitted to the head.&#8221; Concussions leave the individual with both short- and long-term effects. The short-term effects of sport related concussions may include changes in playing ability, confusion, memory disturbance, the loss of consciousness, slowing of reaction time, loss of coordination, headaches, dizziness, vomiting, changes in sleep patterns and mood changes. These symptoms typically resolve in a matter of days. However, while some individuals recover from a single concussion rather quickly, many experience lingering effects that can last for weeks or months. The factors related to concussion susceptibility and the subsequent recovery times are not well known or understood at this time. Several factors have been suggested and they include the individual&#8217;s concussion history, the severity of the initial injury, history of migraines, history of learning disabilities, history of psychiatric comorbidities, and possibly, genetic factors. Many studies have individually investigated certain factors both the short-term and long-term effects of concussions, recovery time course, susceptibility and recovery. What has not been clearly established is an effective multifaceted approach to concussion evaluation that would yield valuable information related to the etiology, functional changes, and recovery. The purpose of this manuscript is to show one such multifaceted approached which examines concussions using computerized neurocognitive testing, event related potentials, somatosensory perceptual responses, balance assessment, gait assessment and genetic testing.

There is great variability in an individual&#8217;s risk for concussion and their corresponding recovery. A multifaceted approach to concussion evaluation is warranted; including baseline testing of athletes before participation in sport and timely evaluation post injury. The goal of this protocol is to provide an appropriate multifaceted approach to examine concussions.

Uma abordagem neurocientífica para o Exame de abalos em alunos-atletas

Concussions are occurring at alarming rates in the United States and have become a serious public health concern. The CDC estimates that 1.6 to 3.8 ...

Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination

Common foot and ankle pathologies have been linked to isolated Musculus gastrocnemius tightness (MGT). Various examination techniques have been described to assess MGT. Still, a standardized examination procedure is missing. Literature argues for weightbearing examination but the degree of knee flexion needed to eliminate the restraining effect of the M. gastrocnemius on ankle dorsiflexion (ADF) is unknown. This manuscript investigates the effect of knee flexion on ankle dorsiflexion and provides a detailed description of a standardized examination protocol. Examination on 20 healthy individuals revealed, that 20&#176; of knee flexion is sufficient to fully eliminate the influence of the M. gastrocnemius on ADF. This builds the prerequisite for a standardized examination for MGT. Non-weightbearing and weightbearing examination of ADF has to be conducted with the knee fully extended and at least 20&#176; flexed. Two investigators should conduct non-weightbearing testing with the subject in supine position. In order to obtain reliable results, the axis of the fibula should be marked. One examiner can conduct weightbearing examination with the subject in lunge stance. Isolated MGT is present if ADF is impaired with the knee fully extended and knee flexion results in a significant ADF increase. The herein presented standardized examination is the prerequisite for future studies aiming at establishing norm values.

Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination

Isolated Musculus gastrocnemius tightness is a common cause for foot and ankle pathologies. Currently no standardized examination procedure exists. This manuscript demonstrates that 20 degree of knee flexion eliminates the restraining effect of the M. gastrocnemius on ankle dorsiflexion and presents a video description of a standardized examination protocol.

diagnóstico de<em&gt; Musculus Gastrocnemius</em&gt; Aperto - fatores-chave para o exame clínico

Common foot and ankle pathologies have been linked to isolated Musculus gastrocnemius tightness (MGT). Various examination techniques have been described ...

Echocardiographic and Histological Examination of Cardiac Morphology in the Mouse

An increasing number of genetically modified mouse models has become available in recent years. Moreover, the number of pharmacological studies performed in mice is high. Phenotypic characterization of these mouse models also requires the examination of cardiac function and morphology. Echocardiography and magnetic resonance imaging (MRI) are commonly used approaches to characterize cardiac function and morphology in mice. Echocardiographic and MRI equipment specialized for use in small rodents is&#160;expensive and requires a dedicated space. This protocol describes cardiac measurements in mice using a clinical echocardiographic system with a 15 MHz human vascular probe. Measurements are performed on anesthetized adult mice. At least three image sequences are recorded and analyzed for each animal in M-mode in the parasternal short-axis view. Afterwards, cardiac histological examination is performed, and cardiomyocyte diameters are determined on hematoxylin-eosin- or wheat germ agglutinin (WGA)-stained paraffin sections. Vessel density is determined morphometrically after Pecam-1 immunostaining. The protocol has been applied successfully to pharmacological studies and different genetic animal models under baseline conditions, as well as after experimental myocardial infarction by the permanent ligation of the left anterior descending coronary artery (LAD). In our experience, echocardiographic investigation is limited to anesthetized animals and is feasible in adult mice weighing at least 25 g.

Echocardiographic examination is frequently used in mice. Expensive high-resolution ultrasound devices have been developed for this purpose. This protocol describes an affordable echocardiographic procedure combined with histological morphometric analyses to determine cardiac morphology.

Exame ecocardiográfico e histológico da morfologia cardíaca no Mouse

An increasing number of genetically modified mouse models has become available in recent years. Moreover, the number of pharmacological studies performed ...

Protocol to Create Chronic Wounds in Diabetic Mice

Chronic wounds develop as a result of defective regulation in one or more complex cellular and molecular processes involved in proper healing. They impact ~6.5M people and cost ~$40B/year in the US alone. Although a significant effort has been invested in understanding how chronic wounds develop in humans, fundamental questions remain unanswered. Recently, we developed a novel mouse model for diabetic chronic wounds that have many characteristics of human chronic wounds. Using db/db-/- mice, we can generate chronic wounds by inducing high levels of oxidative stress (OS) in the wound tissue immediately after wounding, using a one-time treatment with inhibitors specific to the antioxidant enzymes catalase and glutathione peroxidase. These wounds have high levels of OS, develop biofilm naturally, become fully chronic within 20 days after treatment and can remain open more for more than 60 days. This novel model has many features of diabetic chronic wounds in humans and therefore can contribute significantly to advancing fundamental understanding of how wounds become chronic. This is a major breakthrough because chronic wounds in humans cause significant pain and distress to patients and result in amputation if unresolved. Moreover, these wounds are very expensive and time-consuming to treat, and lead to significant loss of personal income to patients. Advancements in this field of study through the use of our chronic wound model can significantly improve health care for millions who suffer under this debilitating condition. In this protocol, we describe in great detail the procedure to cause acute wounds to become chronic, which has not been done before.

Chronic wounds are developed from acute wounds on a diabetic mouse model by inducing high levels of oxidative stress after a full-thickness cutaneous wound. The wound is treated with inhibitors for catalase and glutathione peroxidase, resulting in impaired healing and biofilm development by bacteria present in the skin microbiome.

Protocolo para criar feridas crônicas em camundongos diabéticos

Chronic wounds develop as a result of defective regulation in one or more complex cellular and molecular processes involved in proper healing. They impact ...

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based three-chamber bags (3CBs) and soybean-oil-based compounded bags (CoBs) in hospitalized adult patients. We designed a multicenter, randomized, prospective, open-label, noninferiority protocol to compare the efficacy, safety, and distribution of olive-oil-based 3CBs and soybean-oil-based CoB formulations in adult Chinese patients requiring PN during surgical intervention. Subjects were randomized to receive either one of the study treatments using an interactive voice or web-based recognition system in accordance with the randomization code. Randomization was further stratified based on the study site and surgical category. Both treatment groups received similar amounts of calories and protein. In addition, the two study treatments contained a similar composition of the amino-acid component. The only difference between the two PN formulations was the lipid constitution. The duration of administration of study treatments was a minimum of 5 days up to a maximum of 14 days after the surgical procedure. The primary efficacy endpoint was serum prealbumin levels on day 5 of the study. Noninferiority was proved if the anti-log of the lower bound of the 95% confidence interval (CI) of the treatment difference was at least 0.80. Other efficacy measures included treatment preparation time; duration to achieve tolerability of oral nutrition; associated infectious complications; length of hospitalization; and laboratory assessment of markers of nutrition, inflammation, metabolism, and oxidative stress. A total of 458 patients were enrolled in the study. The results showed that olive-oil-based 3CBs were non-inferior to soybean-based CoBs, besides being well tolerated. The infection rate was found to be significantly lower in the olive-oil-based 3CB group. Thus, this study may be used as a reference for future research on lipid emulsion and 3CBs.

Here, we present a protocol for a study comparing the efficacy, safety, and delivery of olive-oil-based 3CB and soybean-oil-based CoB formulations in adults requiring parenteral nutrition. The results revealed that olive-oil-based 3CBs is non-inferior and well tolerated compared to soybean formulations.

Um ensaio clínico avaliando a segurança, eficácia e entrega de sacos de três câmaras à base de azeite para nutrição parenteral

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based ...

Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies

Longitudinal evaluations of critically ill patients by combinations of clinical examination, biochemical analysis and critical care ultrasonography (CCUS) may detect adverse events of interventions such as fluid overload at an early stage. The Simple Intensive Care Studies (SICS) is a research line that focuses on the prognostic and diagnostic value of combinations of clinical variables.
The SICS-I specifically focused on the use of clinical variables obtained within 24 h of acute admission for prediction of cardiac output (CO) and mortality. Its sequel, SICS-II, focuses on repeated evaluations during ICU admission. The first clinical examination by trained researchers is performed within 3 h after admission consisting of physical examination and educated guessing. The second clinical examination is performed within 24 h after admission and includes physical examination and educated guessing, biochemical analysis and CCUS assessments of heart, lungs, inferior vena cava (IVC) and kidney. This evaluation is repeated at days 3 and 5 after admission. CCUS images are validated by an independent expert, and all data is registered in an online secured database. Follow-up at 90 days includes registration of complications and survival status according to patient&#39;s medical charts and the municipal person registry. The primary focus of SICS-II is the association between venous congestion and organ dysfunction.
The purpose of publishing this protocol is to provide details on the structure and methods of this on-going prospective observational cohort study allowing answering multiple research questions. The design of the data collection of combined clinical examination and CCUS assessments in critically ill patients are explicated. The SICS-II is open for other centers to participate and is open for other research questions that can be answered with our data.

Structured protocols are necessary to provide answers on research questions in critically ill patients. The Simple Intensive Care Studies (SICS) provides an infrastructure for repeated measurements in critically ill patients including clinical examination, biochemical analysis and ultrasonography. SICS projects have specific focus but the structure is flexible to other investigations.

Protocolo de estudo observacional para exame clínico repetida e crítico conta ultra-sonografia dentro dos estudos de simples cuidados intensivos

Longitudinal evaluations of critically ill patients by combinations of clinical examination, biochemical analysis and critical care ultrasonography (CCUS) ...

Transthoracic Echocardiographic Examination in the Rabbit Model

Large animal models such as the rabbit are valuable for translational preclinical research. Rabbits have a similar cardiac electrophysiology compared to that of humans and that of other large animal models such as dogs and pigs. However, the rabbit model has the additional advantage of lower maintenance costs compared to other large animal models. The longitudinal evaluation of cardiac function using echocardiography, when appropriately implemented, is a useful methodology for preclinical assessment of novel therapies for heart failure with reduced ejection fraction (e.g. cardiac regeneration). The correct use of this non-invasive tool requires the implementation of a standardized examination protocol following international guidelines. Here we describe, step by step, a detailed protocol supervised by veterinary cardiologists for performing echocardiography in the rabbit model, and demonstrate how to correctly obtain the different echocardiographic views and imaging planes, as well as the different imaging modes available in a clinical echocardiography system routinely used in human and veterinary patients.

Here we describe, step by step, a detailed protocol for performing echocardiography in the rabbit model. We show how to correctly obtain the different echocardiographic views and imaging planes, as well as the different imaging modes available in a clinical echocardiography system routinely used in human and veterinary patients.

Exame ecocardiográfico transtorácico no modelo coelho

Large animal models such as the rabbit are valuable for translational preclinical research. Rabbits have a similar cardiac electrophysiology compared to ...

Clinical Practice Protocol of Creative Music Therapy for Preterm Infants and Their Parents in the Neonatal Intensive Care Unit

Creative music therapy for preterm infants and their parents (CMT) has emerged as a promising family-integrated early intervention involving communicative musicality to improve infant development, parental well-being, and bonding. It aims at relaxing and nurturing the infant as well as promoting safety and social interaction for the parent-infant dyad. A music therapist specially trained in CMT hums or sings in an infant-directed, improvised, lullaby style continually adjusting to the individual needs, expressions, and breathing pattern of the preterm infant. Based on the principles of family-integrated care, the family is incorporated individually in the therapeutic process, namely by delivering CMT during kangaroo care (KC) and by motivating and facilitating parental vocal interaction with their infant to strengthen the parent-infant bonding. CMT aims at relaxing, stimulating, and coregulating premature infants at a time when many other interventions are still risky and can overwhelm the vulnerable patient group. CMT may be advantageous not by educating and teaching parents, but rather by uncovering the intuitive capacities of parenting that are often overshadowed by the traumatic experience of preterm birth. However, CMT can only be provided when the infants are clinically stable. CMT with parental integration is feasible when parents are available and receptive to participate. This paper presents a detailed protocol on how to use CMT to empower preterm infants and their families.

Creative music therapy for preterm infants and their parents has emerged as a promising family-integrated early intervention. We present a detailed protocol on how to use vocal interaction, humming, or singing to empower preterm infants and their families.

Protocolo de Prática Clínica de Musicoterapia Criativa para Bebês Prematuros e seus pais na Unidade de Terapia Intensiva Neonatal

Creative music therapy for preterm infants and their parents (CMT) has emerged as a promising family-integrated early intervention involving communicative ...